Polypharmacy in pediatric oncologist practice
https://doi.org/10.21682/2311-1267-2026-13-1-69-79
Abstract
Today, the problem of polypharmacy is extremely important for all medical specialties, however, in pediatric oncology, it is determined by the specific treatment characteristics of the underlying disease, including combination antitumor therapy regimens, as well as the need to correct associated multisystem complications using various classes of drugs. The key risks of polypharmacy include an increased likelihood of drug interactions, adverse drug reactions, cognitive impairment, and prolonged hospitalization, as well as decreased treatment effectiveness and patient quality of life. However, there is limited research on optimizing drug therapy prescriptions. This article outlines the basic concepts of polypharmacy and review existing practical strategies for managing drug therapy prescription skills in pediatric oncology.
Supporting agencies: The study was carried out with the financial support of the Ministry of Science and Higher Education of the Russian Federation in the framework of a scientific project under agreement No. 075-15-2025-013 from 14.06.2024.
About the Authors
Yu. V. Dinikina
Almazov National Medical Research Centre, Ministry of Health of Russia; Saint Petersburg State University
Russian Federation
Russian Federation
Dr. of Sci. (Med.), Associate Professor, Head of the Department of Chemotherapy for Hematologic Diseases and Bone Marrow Transplantation for Children; Senior Researcher, Laboratory of probabilistic methods of analysis
2 Akkuratova St., Saint Petersburg, 197341
7–9 Universitetskaya Embankment, Saint Petersburg, 199034
I. L. Nikitina
Almazov National Medical Research Centre, Ministry of Health of Russia
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Head of the Research Laboratory of Pediatric Endocrinology, Institute of Endocrinology
2 Akkuratova St., Saint Petersburg, 197341
References
1. Ribeiro E., Pedrosa S. Evaluation of potential drug interactions in hospitalized pediatric oncology patients. Mundo da Saude. 2020;45:34–44, e1132020. doi: 10.15343/0104-7809.202145034044.
2. Ewig C.L.Y., Cheng Y.M., Li H.S., Wong J.C.L., Cho A.H.Y., Poon F.M.H., Li C.K., Cheung Y.T. Use of chronic prescription medications and prevalence of polypharmacy in survivors of childhood cancer. Front Oncol. 2021;11:642544. doi: 10.3389/fonc.2021.642544.
3. Otth M., Wyss J., Scheinemann K. Long-term follow-up of pediatric CNS tumor survivors – a selection of relevant long-term issues. Children (Basel). 2022;9(4):447. doi: 10.3390/children9040447.
4. Fernández de Palencia Espinosa M.A., Díaz Carrasco M.S., Fuster Soler J.L., Ruíz Merino G., De la Rubia Nieto M.A., Espuny Miró A. Pharmacoepidemiological study of drug-drug interactions in onco-hematological pediatric patients. Int J Clin Pharm. 2014;36:1160–9. doi: 10.1007/s11096-014-0011-1.
5. Riechelmann R.P., Zimmermann C., Chin S.N., Wang L., O'Carroll A., Zarinehbaf S., Krzyzanowska M.K. Potential drug interactions in cancer patients receiving supportive care exclusively. J Pain Symptom Manage. 2008;35(5):535–43. doi: 10.1016/j.jpainsymman.2007.06.009.
6. Masnoon N., Shakib S., Kalisch-Ellett L., Caughey G.E. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. doi: 10.1186/s12877-017-0621-2.
7. Dai D., Feinstein J.A., Morrison W., Zuppa A.F., Feudtner C. Epidemiology of polypharmacy and potential drug-drug interactions among pediatric patients in ICUs of U.S. Children's Hospitals. Pediatr Crit Care Med. 2016;17(5):e218–28. doi: 10.1097/PCC.0000000000000684.
8. Varghese D., Ishida C., Patel P., Koya H.H. Polypharmacy. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2025 Jan. [Electronic resource]: https://www.ncbi.nlm.nih.gov/books/NBK532953. (accessed 10.08.2025).
9. Sychev D.A. Polypragmasia in clinical practice: problem and solutions: textbook. Moscow, 2016. 249 p. ISBN 978-5-72492542-6. (In Russ.).
10. Batchelor H.K., Marriott J.F. Paediatric pharmacokinetics: key considerations. Br J Clin Pharmacol. 2015;79(3):395–404. doi: 10.1111/bcp.12267.
11. Hughes C. Appropriate and inappropriate polypharmacy-choosing the right strategy. Br J Clin Pharmacol. 2021;87(1):84–6. doi: 10.1111/bcp.14589.
12. Baker C., Feinstein J.A., Ma X., Bolen S., Dawson N.V., Golchin N., Horace A., Kleinman L.C., Meropol S.B., Pestana Knight E.M., Winterstein A.G., Bakaki P.M. Variation of the prevalence of pediatric polypharmacy: a scoping review. Pharmacoepidemiol Drug Saf. 2019;28(3):275–87. doi: 10.1002/pds.4719.
13. Fraser L.K., Gibson-Smith D., Jarvis S., Neefjes V., Hills M., Doran T., Taylor J. Polypharmacy in children and young people with life-limiting conditions from 2000 to 2015: a repeated cross-sectioonal study in England. J Pain Symptom Manage. 2022;64:213–21. doi: 10.1016/j.jpainsymman.2022.05.020.
14. Feudtner C., Kang T.I., Hexem K.R., Friedrichsdorf S.J., Osenga K., Siden H., Friebert S.E., Hays R.M., Dussel V., Wolfe J. Pediatric palliative care patients: a prospective multicenter cohort study. Pediatrics. 2011;127(6):1094–101. doi: 10.1542/peds.2010-3225.
15. Peláez Cantero M.J., Morales Asencio J.M., Navarro Marchena L., Velázquez González M.D.R., Sánchez Echàniz J., Rubio Ortega L., Martino Alba R. End of life in patients under the care of paediatric palliative care teams. Multicentre observational study. An Pediatr (Engl Ed). 2022;96(5):394–401. doi: 10.1016/j.anpede.2022.04.008.
16. Smitherman A.B., Mohabir D., Wilkins T.M., Blatt J., Nichols H.B., Dusetzina S.B. Early post-therapy prescription drug usage among childhood and adolescent cancer survivors. J Pediatr. 2018;195:161–8.e7. doi: 10.1016/j.jpeds.2017.11.063.
17. Ewig C.L.Y., Cheng Y.M., Li H.S., Wong J.C.L., Cho A.H.Y., Poon F.M.H., Li C.K., Cheung Y.T. Use of chronic prescription medications and prevalence of polypharmacy in survivors of childhood cancer. Front Oncol. 2021;11:642544. doi: 10.3389/fonc.2021.642544.
18. Asetskaya I.L. Drug interactions: What does a clinician need to know? (lecture). Pediatrics. Appendix to the Journal Consilium Medicum 2024;4:76–81 (In Russ.).
19. Riechelmann R.P., Saad E.D. A systematic review on drug interactions in oncology. Cancer Invest. 2006;24(7):704–12. doi: 10.1080/07357900601063766.
20. Elzagallaai A.A., Carleton B.C., Rieder M.J. Pharmacogenomics in pediatric oncology: mitigating adverse drug reactions while preserving efficacy. Ann Rev Pharmacol Toxicol. 2021;61:679–99. doi: 10.1146/annurev-pharmtox-031320-104151.
21. Balk T.E., van der Sijs I.H., van Gelder T., Janssen J.J.B., van der Sluis I.M., van Leeuwen R.W.F., Engels F.K. Drug-drug interactions in pediatric oncology patients. Pediatr Blood Cancer. 2017;64(7). doi: 10.1002/pbc.26410.
22. Visentin M., Biason P., Toffoli G. Drug interactions among the epidermal growth factor receptor inhibitors, other biologics and cytotoxic agents. Pharmacol Ther. 2010;128:82–90.
23. Machover D. A comprehensive review of 5-fluorouracil and leucovorin in patients with metastatic colorectal carcinoma. Cancer. 1997;80:1179–87. doi: 10.1002/(sici)10970142(19971001)80:7<1179::aid-cncr1>3.0.co;2-g.
24. Ribeiro E., Pedrosa S. Evaluation of potential drug interactions in hospitalized pediatric oncology patients. Mundo de Saude. 2021;45:034–44. doi: 10.15343/0104-7809.202145034044.
25. Ken-ichi F. Cytochrome P450 and anticancer drugs. Curr Drug Metab. 2006;7:23–37. doi: 10.2174/138920006774832587.
26. Micromedex healthcare series: interactions (updated periodically). Thomson Reuters (Healthcare) Inc. [Electronic resource]: http://www.micromedexsolutions.com/home/dispatch (accessed 01.03.2013).
27. Groll A.H., Desai A., Han D., Howieson C., Kato K., Akhtar S., Kowalski D., Lademacher C., Lewis W., Pearlman H., Mandarino D., Yamazaki T., Townsend R. Pharmacokinetic assessment of drug-drug interactions of isavuconazole with the immunosuppressants cyclosporine, mycophenolic acid, prednisolone, sirolimus, and tacrolimus in healthy adults. Clin Pharmacol Drug Dev. 2017;6(1):76–85. doi: 10.1002/cpdd.284.
28. Rybak M.J., Albrecht L.M., Boike S.C., Chandrasekar P.H. Nephrotoxicity of vancomycin, alone and with an aminoglycoside. J Antimicrob Chemother. 1990;25(4):679–87. doi: 10.1093/jac/25.4.679.
29. Balis F.M., Holcenberg J.S., Zimm S., Tubergen D., Collins J.M., Murphy R.F., Gilchrist G.S., Hammond D., Poplack D.G. The effect of methotrexate on the bioavailability of oral 6-mercaptopurine. Clin Pharmacol Ther. 1987;41(4):384–7. doi: 10.1038/clpt.1987.45.
30. Andersen J.B., Szumlanski C., Weinshilboum R.M., Schmiegelow K. Pharmacokinetics, dose adjustments, and 6-mercaptopurine/ methotrexate drug interactions in two patients with thiopurine methyltransferase deficiency. Acta Paediatr. 1998;87(1):108–11. doi: 10.1080/08035259850158001.
31. Aagard L., Christensen A., Hansen E.H. Information about adverse drug reactions reported in children: a qualitative review of empirical studies. Br J Clin Pharmacol. 2010;70(4):481–91. doi: 10.1111/j.1365-2125.2010.03682.x.
32. Fakhry H., Goldenberg M., Sayer G., Aye S.S., Bagot K., Pi S., Ghazzaoui R., Vo N., Gowrinathan S., Bolton M., IsHak W.W. Health-related quality of life in childhood cancer. J Dev Behav Pediatr. 2013;34:419–40. doi: 10.1097/DBP.0b013e31828c5fa6.
33. Elzagallaai A.A., Greff M., Rieder M.J. Adverse drug reactions in children: the double-edged sword of therapeutics. Clin Pharmacol Ther. 2017;101:25–35. doi: 10.1002/cpt.677.
34. Clemens E., van der Kooi A.L.F., Broer L., van Dulmenden Broeder E., Visscher H., Kremer L., Tissing W., Loonen J., Ronckers C.M., Pluijm S.M.F., Neggers S.J.C.M.M., Zolk O., Langer T., Zehnhoff-Dinnesen A.A., Wilson C.L., Hudson M.M., Carleton B., Laven J.S.E., Uitterlinden A.G., van den Heuvel-Eibrink M.M. The influence of genetic variation on late toxicities in childhood cancer survivors: a review. Crit Rev Oncol Hematol. 2018;126:154–67. doi: 10.1016/j.critrevonc.2018.04.001.
35. Taylor Z.L., Vang J., Lopez-Lopez E., Oosterom N., Mikkelsen T., Ramsey L.B. Systematic review of pharmacogenetic factors that influence high-dose methotrexate pharmacokinetics in pediatric malignancies. Cancers. 2021;13(2837):1–20. doi: 10.3390/cancers13112837.
36. Bernsen E.C., Hagleitner M.M., Kouwenberg T.W., Hanff L.M. Pharmacogenomics as a tool to limit acute and long-term adverse effects of chemotherapeutics: an update in pediatric oncology. Front Pharmacol. 2020;11:1184. doi: 10.3389/fphar.2020.01184.
37. Franczyk B., Rysz J., Gluba-Brzózka A. Pharmacogenetics of drugs used in the treatment of cancers. Genes. 2022;13(311):2–31. doi: 10.3390/genes13020311.
38. Urtasun A., Olivera G.G., Senndra L., Alino S.F., Berlanga P., Gargallo P., Hervas D., Balaguer J., Juan-Ribelles A., del Mar Andres M., Canete A., Herrero M.J. Personilized medicine in infant population with cancer: pharmacogenetic pilot study of polymprphisms related to toxicity and response to chemotherapy. Cancers. 2023;15(1424):2–14. doi: 10.3390/cancers1501424.
39. Yang X., Li G., Yang T., Guan M., An N., Yang F., Dai Q., Zhong C., Luo C., Gao Y., Das S., Xing Y., Shang H., Shang H. Possible susceptibility genes for intervention against chemotherapy-induced cardiotoxicity. Oxid Med Cell Longev. 2020;2020:4894625. doi: 10.1155/2020/4894625.
40. Morris S.A., Nguyen D.G., Patel J.N. Pharmacogenomics in allogeneic hematopoietic stem cell transplantation: Implications on supportive therapies and conditioning regimens. Best Pract Res Clin Haematol. 2023;36(2):101470. doi: 10.1016/j.beha.2023.101470.
41. [Electronic resource]: https://www.drugs.com/drug_interactions.htm (accessed 10.08.2025).
42. [Electronic resource]: https://reference.medscape.com/druginteractionchecker (accessed 10.08.2025)
43. [Electronic resource]: https://go.drugbank.com/drug-interactionchecker (accessed 10.08.2025).
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For citations:
Dinikina Yu.V., Nikitina I.L. Polypharmacy in pediatric oncologist practice. Russian Journal of Pediatric Hematology and Oncology. 2026;13(1):69-79. (In Russ.) https://doi.org/10.21682/2311-1267-2026-13-1-69-79
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